Provider Demographics
NPI:1275650509
Name:IMC - HAND AVE FAMILY PRACTICE P.C.
Entity Type:Organization
Organization Name:IMC - HAND AVE FAMILY PRACTICE P.C.
Other - Org Name:JAMES O. DEVANEY, M.D., P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:DEVANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-937-7796
Mailing Address - Street 1:2002 MCMILLAN AVE
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4134
Mailing Address - Country:US
Mailing Address - Phone:251-937-7796
Mailing Address - Fax:251-937-1250
Practice Address - Street 1:2002 MCMILLAN AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4134
Practice Address - Country:US
Practice Address - Phone:251-937-7796
Practice Address - Fax:251-937-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI441Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ALC70044Medicare UPIN